Introducing Critical Care Outreach: a ward-randomised trial of phased introduction in a general hospital

Abstract

Objective

The purpose of the study was to investigate the effects of introducing a critical care outreach service on in-hospital mortality and length of stay in a general acute hospital.

Design

A pragmatic ward-randomised trial design was used, with intervention introduced to all wards in sequence. No blinding was possible.

Setting

Sixteen adult wards in an 800-bed general hospital in the north of England.

Patients and participants

All admissions to the 16 surgical, medical and elderly care wards during 32-week study period were included (7450 patients in total, of whom 2903 were eligible for the primary comparison).

Interventions

Essential elements of the Critical Care Outreach service introduced during the study were a nurse-led team of nurses and doctors experienced in critical care, a 24-h service, emphasis on education, support and practical help for ward staff.

Measurements and results

The main outcome measures were in-hospital mortality and length of stay. Outreach intervention reduced in-hospital mortality compared with control (two-level odds ratio: 0.52 (95% CI 0.32–0.85). A possible increased length of stay associated with outreach was not fully supported by confirmatory and sensitivity analyses.

Conclusions

The study suggests outreach reduces mortality in general hospital wards. It may also increase length of stay, but our findings on this are equivocal.

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Acknowledgements

We thank the following people for their support for this study: K. Martin, K. Harrison, H. Paw, G. Cundill, M. Reeder, I. Woods, C. Barr, M. Clubbs, J. Miles, M. Yang, G. Dunn and E. Grant. This work was supported by the York Research Innovation Fund (York Hospitals NHS Trust).

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Correspondence to Caroline Mozley.

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An editorial regarding this article can be found in the same issue (http://dx.doi.org/10.1007/s00134-004-2269-6)

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Priestley, G., Watson, W., Rashidian, A. et al. Introducing Critical Care Outreach: a ward-randomised trial of phased introduction in a general hospital. Intensive Care Med 30, 1398–1404 (2004). https://doi.org/10.1007/s00134-004-2268-7

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Keywords

  • Critical care
  • Intensive care
  • Hospital mortality
  • Length of stay